Precision Public Health
Traditional public health practice has had a central reliance on data, and the core discipline of epidemiology, in order to inform health policy and priority-setting, drive health improvement across whole populations, and target disadvantaged populations. Core activities include risk factor and disease surveillance, screening, development of interventions and evaluation. Since the 1970s, New Public Health has also emphasised community engagement, health promotion, partnerships and advocacy.
In the last twenty years, and particularly with the sequencing of the human genome and advances in information communications technology, new possibilities are opening up for a much more finely delineated view of the ‘time-person-place’ triad, and hence a paradigm shift in public health. We propose wider use of the term ‘Precision Public Health’ to complement the parallel developments in medicine such as Personalised Medicine and Precision Medicine (a term used in a 2011 US National Academy of Sciences Report).
We are excited by the potential contribution of new fields such as genomics, other ‘-omics’ platforms (particularly phenomics and exposomics) and spatial health (geographic information systems or GIS), which together with new monitoring, wearable and mobile sensor devices allow for a more precise view of individuals and their behaviours over their life course, and within their community and local environments.
Furthermore, it is the combination of these new fields and the ability to aggregate, analyse and disseminate much larger amounts of data through advances in data linkage, bio-informatics and communications technologies, that holds even greater promise for advancing public health. In short, we should be aiming to combine the cloud (as in data) and the crowd (as in crowdsourcing and population benefit).
Nevertheless, we have to be aware that public health cannot advance by technology alone, and public health practice must remain grounded in the everyday reality of people’s lives. We need to be mindful of the need for validation of tools and tests, and the steps and pitfalls on the route from cell to bench to person to population. Measurement, classification and language issues may cloud as well as assist accurate interpretation. We also need to be cautious about ethical implications of the new precision technologies for consent and privacy, and indeed their potential to create unnecessary anxiety (through over-testing) and widen existing population-level inequalities.
We propose the following definition of ‘precision public health’: the application and combination of new and existing technologies, which more precisely describe and analyse individuals and their environment over the life course, in order to tailor preventive interventions for at-risk groups and improve the overall health of the population.
Journal of Health and Medical Research
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